Second in a Series: What My Grandmother Taught Me

The AARP Solutions Forum: “Advancing Health in Rural America: Maximizing Nursing’s Impact,” was held on June 13. This post is the second in a series in which Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars, who viewed the forum live, share their thoughts on the ideas presented. The author, Andrea Wallace, R.N., Ph.D., is an assistant professor at the University of Iowa College of Nursing and focuses her research on finding means of improving outcomes for those living with chronic illness, particularly for vulnerable patient populations. Find out more about the forum or view the archived webcast.

At a tender age, I watched my beloved grandmother—who lived on a farm 18 miles of dirt road off a two-lane state highway, 40 miles from a town of 5,000—develop complications from a vascular condition. My family was fortunate in that it didn’t take my parents long to discover the vast differences in the quality of services available in my grandparents’ rural community, compared to those in urban Denver. So, multiple times per year, with the assistance of a large vascular center’s RN case manager, my parents would arrange for her to be seen in Denver, often driving eight hours to make it happen.

Much of the conversation about rural health care delivery still focuses on access. While geography is an enormous barrier to access, and access is required to improve health outcomes, the panelists at last week’s event again reminded viewers that improving the quality of care for rural Americans is not simply about placing warm bodies into clinical care. Rather, it is about adopting effective, innovative, high quality practices related to population health, using interdisciplinary teams, and allowing nurses to practice to the full extent of their licenses.

Unlike when my grandmother was seen, we now have many forms of technology to facilitate the education of nurses and other health care providers who work in rural settings, and telemedicine to give support to rural primary care providers. We are now in an era in which we can move toward taking the important next steps of adapting and implementing best practices from around the globe in rural settings.

As a Robert Wood Johnson Foundation Nurse Faculty Scholar, I am working with four community health clinics located throughout the state of Iowa to develop means of implementing best practices related to diabetes care. As such, I was thrilled to hear of the panelists’ experiences, projects that are currently underway, and how this year’s policy developments can be used to drive innovation to lessen the disparities in health care quality that affect Americans living in rural settings.

Learning how this can be done is likely to benefit everyone. While the differences in health care quality are exacerbated by geography, it can take as little as the few feet of space between exam rooms to make a world of difference in patient outcomes.